Today’s Top Story
President Trump issues executive order to weaken impact of ACA.
On his first day in office, President Trump has issued an executive order that directs applicable federal agencies to undermine the Affordable Care Act (ACA) through regulatory action. Among other things, the order instructs the Secretary of Health and Human Services and other department heads to “exercise all authority and discretion available to them to waive, defer, grant exemptions from, or delay the implementation of any provision or requirement of the Act that would impose a fiscal burden on any State or a cost, fee, tax, penalty, or regulatory burden on individuals, families, healthcare providers, health insurers, patients, recipients of healthcare services, purchasers of health insurance, or makers of medical devices, products, or medications.” Observers note only the U.S. Congress can rescind the ACA, but the order may alter the way certain provisions are enforced.
Read more…
Read the executive order…
In related news, presidential advisor Kellyanne Conway said in an interview with ABC News that Mr. Trump is considering no longer enforcing the ACA mandate for individuals to carry health insurance.
Read more…
Other News
Senators introduce bill to give states the option of retaining the ACA.
The New York Times reports that two senators have introduced a bill to replace the ACA that would, if enacted, grant states the option of continuing to operate under the ACA if they so choose. Under the proposal, states that reject the ACA could receive a similar amount of federal money for their own programs. The bill also encourages greater use of health savings accounts and eliminates the individual mandate.
Read more…
Study: Plate fixation may improve likelihood of bone healing for patients with diaphyseal fracture of the clavicle.
Findings from a study published in the Jan. 18 issue of The Journal of Bone & Joint Surgery (JBJS) suggest that for certain patients with a diaphyseal fracture of the clavicle, the bone may be more likely to heal when treated with plate fixation than nonoperative treatment. The authors conducted a randomized, controlled trial of 160 patients aged 18 to 60 years who were treated with open reduction with internal plate fixation or nonoperatively. At 1-year follow-up, they found that the rate of nonunion was significantly higher in the nonoperative cohort compared to the plate fixation cohort. They note that the rate of secondary operation was 27.4 percent in the operative group (16.7 percent for elective plate removal) and 17.1 percent in the nonoperative group. Overall, 19 percent of patients in the operative group had persistent loss of sensation around the scar. The authors found no difference across cohorts with respect to Constant shoulder and Disabilities of the Arm, Shoulder and Hand scores at any time point.
Read the abstract…
Study: Low-dose aspirin may not be inferior to high-dose aspirin for VTE prophylaxis following TJA.
According to a study published in the Jan. 18 JBJS, low-dose aspirin may not be inferior to high-dose aspirin for prevention of venous thromboembolism (VTE) following total joint arthroplasty (TJA). The research team reviewed data on 4,651 TJA patients, 3,192 of whom received enteric-coated 325-mg aspirin twice daily for 4 weeks and 1,459 of whom received 81-mg aspirin twice daily for 4 weeks. They found no significant difference between cohorts in incidence of VTE, gastrointestinal bleeding, or ulceration, and the 90-day mortality rate was similar in both groups. However, the incidence of acute periprosthetic joint infection was higher in the 325-mg aspirin group (0.2 percent vs. 0.5 percent).
Read the abstract…
Study: Sepsis a leading cause of expense among 30-day readmissions.
A research letter published in the Jan. 22 issue of The Journal of the American Medical Association finds sepsis to be a leading cause of hospital readmissions, and argues that adding sepsis to the U.S. Centers for Medicare & Medicaid Services (CMS) Hospital Readmission Reduction Program may help lead to development of new interventions to reduce unplanned readmissions and associated costs. The researchers analyzed data from the 2013 Nationwide Readmissions Database and identified 1,187,697 index admissions for medical reasons that were followed by an unplanned hospital readmission within 30 days of discharge. They found that the mean length of stay for unplanned readmissions following sepsis hospitalization was longer than that of readmissions following acute myocardial infarction, heart failure, chronic obstructive pulmonary disease, and pneumonia. In addition, the estimated mean cost per readmission was highest for sepsis compared with the other diagnoses.
Read the abstract…
Study: Removal of physician supervision of anesthesia requirement linked to little or no improved access.
Data from a study published online in the journal Anesthesia suggest that implementation of a CMS rule allowing U.S. states to “opt out” of regulations that require physician supervision of nurse anesthetists may have been associated with little or no increased access to anesthesia for several common procedures. The authors reviewed Medicare claims data for patients undergoing total knee arthroplasty, total hip arthroplasty (THA), hip fracture repair, and several other procedures. They found that “opt out” was not associated with a reduction in the percentage of patients who traveled outside of their home zip code for any procedure except for THA, which saw a 2.2 percent reduction. Among patients travelling outside of their zip code, “opt out” had no significant effect on distance traveled among any of the procedures examined.
Read more…
Read the abstract…
AAOS accepting commentary on proposed Guideline on the Management of Osteoarthritis of the Hip.
The newest AAOS Clinical Practice Guideline on the Management of Osteoarthritis of the Hip has completed peer review and is entering the public commentary stage. If you would like to provide comments on this guideline, please follow the public comment instructions. Public comments will be accepted until Friday, Feb. 3, 2017.
Access the public comment instructions (PDF)…
